Provider Demographics
NPI:1528501467
Name:ROGERS, DAVID ROLAND (PHARMACIST)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROLAND
Last Name:ROGERS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 MISTY WOOD WAY
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95621-3504
Mailing Address - Country:US
Mailing Address - Phone:916-622-7323
Mailing Address - Fax:916-723-4228
Practice Address - Street 1:6301 MISTY WOOD WAY
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95621-3504
Practice Address - Country:US
Practice Address - Phone:916-622-7323
Practice Address - Fax:916-723-4228
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28275OtherCALIFORNIA STATE BOARD OF PHARMACY